Suggest treatment for severe headache

Posted on Tue, 7 Mar 2017 in Headache and Migraines
Question: Yesterday i had such terrible headache during bowel movement. Today happened again and lasted for about half an hour , i had two panadols then got better. I have never experienced sich intensive pain even giving was birth more bearable. I thought even to call an ambulance
Should i be worried? Is there anything that needs urgent check?
I am 50 yrs old , healthy, 162 cm , 59 kg, usually good health i think
Thank you
Answered by Dr. Olsi Taka 32 minutes later
Brief Answer:
Needs urgent check

Detailed Answer:
I read your question carefully and I understand your concern.

Whenever the patient describes a headache as of a sudden onset, of a very high intensity, as the worst headache ever, the first diagnosis which should be considered and excluded would be that of a brain hemorrhage, in particular a subarachnoid hemorrhage. It is a possibility which requires urgent attention, a trip to the ER (emergency room) would be justified to check for neurological signs like neck rigidity and if present brain imaging. The fact that yesterday it got better is heartening, but still it is a possibility to be considered.

I am not sure from your description if it was both times related to bowel movement, or only yesterday. If always related to bowel movement, then there would be some other things to consider, though on a less urgent basis. When headache is related to increased pressure in the abdomen such as straining in the bathroom, coughing etc then it may be an indication of a malformation called XXXXXXX Chiari, a malformation of the skull with the brain tissue descending where the head joins the neck. So brain imaging would help to exclude that possibility as well.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 2 days later
Dear Dr Taka
Thank you very much for your reply, really appreciate!
I have done MRI AND upoladed result
My GP said i dont need anything to do just maybe aspirin once a day but i feel bit uncomfortable and not sure if i need any other investigations or preventive steps
Any blood test? Any suplements?
I would appreciate very much your reply.
I dont think it was a migraine as i didnt have any other signs after these attacks like people with migraines usually have and lasted only about 20 min
Kind regards
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
Wouldn't advise anything else for now.

Detailed Answer:
Hello again and thanks for following up. It is good that you've had a MRI, means that the doctors were thorough as it is the best imaging test. Unfortunately I do not see any result uploaded, the report section is empty. But I assume from what your doctor told you there was none of the issues I feared.

I do not think you need any other investigation really, there's not much else more than the MRI to go to for headache, if that showed nothing you do not need to be afraid. I wouldn't advise any blood tests (unless there are any symptoms indicating issues such as infections, anemia etc), not for brain lesions or malformations. I wouldn't advise any supplements either.

I do not think it was migraine either. At times these episodes may remain isolated. There are some cases of headache without an identifiable cause related to increase in abdominal pressure, usually coughing or sneezing, but bowel movement may create similar circumstances. It does not require treatment usually (as it diminishes before pain killers start to act), but if it is frequent preventive treatment with Indomethacine may be used. I do not think should be started now in your case, only if frequent episodes.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 12 hours later
Thank you!
Sorry, I have uploaded this again and I think my results are available for view now, if you could have look at my MRI findings i would be very grateful
There is one thing that I forgot to mention my neck pain which is persistent and over a year now:I have tried everything -physio, osteopath, massage but nothing works , prevent me from good sleeping . Could be this related? It is not exaduration if i say that is a constant pain that I am living with in the last year, sometimes I take 2 panadols to get relief . i tried numerous pillows to find comfortable position and giving up.This is absolutely constant pain more on left side, maybe it is related and maybe I should investigate neck?
Answered by Dr. Olsi Taka 13 hours later
Brief Answer:
Read below

Detailed Answer:
Hello again.

I reviewed that MRI report. As your GP has told you there is no need for any acute intervention. There are some chronic changes of the blood vessels which are commonly found in migraine patients, but also may be due to vessel changes with age, accelerated by factors such as high blood pressure, diabetes, smoking etc.

As for the neck pain, it may at times radiate in the head but it shouldn't be of an acute onset as you describe it, it comes and goes more gradually, lasting more than 20 minutes. Most probably the neck pain is in the setting of chronic spinal problems. A MRI (non urgent) may be scheduled for that, but in terms of management it wouldn't change much, it would be simply over the counter pain killers such as Ibuprofen when necessary and physical therapy. MRI is reserved mostly for those cases where there are other symptoms apart from neck pain on the neurological exam which might indicate a spinal cord or nerve root compression and surgery might be considered.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Olsi Taka


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